Over the years, I’ve written a lot about AA, mostly about the negative things that are lost in the avalanche of pro-AA testimonials.

Let’s take as a given that AA’s own statistics (AA’s 1989 triennial survey) are correct: 5% of those who walk through the door are still there (and probably sober) a year later. That’s about the rate of spontaneous remission.

My very strong suspicion is that if you’d take away the million-plus people coerced into AA attendance every year in the U.S. (mostly via DUI sentencing and employee assistance programs), the percentage who recover with the help of AA would be a lot higher — that is, if you’d only count those who voluntarily come to AA for help, the recovery rate would probably be twice, maybe three times the rate indicated in AA’s summary report on the 1989 AA triennial survey. (I have to stress here that this is only my own entirely scientifically unsupported estimate, though I suspect that my friends and family who have been in AA for decades would tend to agree.)

Why would this be? Two reasons come to mind: 1) once someone has decided to change, almost any helping hand will increase their chances of recovery; 2) there’s evidence that AA works especially well for religious people, for whom AA’s religiosity isn’t a problem, and is likely an aid.

This brings up the first way that AA could be of more help to alcohol abusers and the alcohol dependent: AA should stop aiding and abetting the coercion of alcohol abusers into AA attendance. This could be easily done by having meeting secretaries stop signing attendance slips. AA’s annual general service conference could easily declare such a policy.

The second way AA could be of more help is if it (okay, the true believers at most AA meetings) would admit that there are other routes to recovery. There’s good evidence that cognitive behavioral therapy (CBT) approaches are the most effective treatment option, and CBT self-help is the foundation of the second-most common alcohol self-help group, SMART Recovery.

That leads to the third way AA could be of more help: AA has an official “take it or leave it” approach (not that this reflects real-world AA), which means that AA could help more people by referring them to SMART Recovery, Lifering, Moderation Management (and other harm-reduction groups), Secular Organizations for Sobriety, Women for Sobriety, and other non-religious recovery groups. These groups can and will help many of those repelled by the rigidity and religiosity of AA.

A fourth way AA (again, the true believers at AA meetings) could be of real help is if AA would stop repeating unscientific, destructive dogma.

Go to almost any AA meeting and you’ll hear that without AA “alcoholics” will inevitably descend into the hell of “jails, institutions, or death.” Abundant scientific research indicates that this simply is not so: most alcohol-dependent persons (not just alcohol abusers) either improve significantly or quit entirely without participation in AA or any other type of treatment program.

So, if AA (the hardcore members) would simply stop repeating the “jails, institutions, or death” mantra, it would help huge numbers of people to take the first step to taking responsibility for their own behavior and recovery (or at least improvement). AA should admit that it is possible to recover independently or simply reduce self-harm, and that doing so is possible and important.

A fifth and very significant way AA could help alcohol abusers is if it (again, the hardcore fanatics at almost every meeting) would stop insisting that “alcoholics” inevitably lose control after a single drink (“one drink, one drunk”). There’s good scientific evidence that this is a self-fulfilling prophecy, and that those having no exposure to AA are significantly less likely to binge than those exposed to AA.

Of course, when those with alcohol problems drink it’s at least to some extent Russian roulette. So, it makes sense not to drink. But pretending that even a single drink inevitably leads to a bender is a horrible, destructive, self-fulfilling prophecy.

If AA (oookay, once again the hardcore believers) would stop insisting on all this pernicious nonsense and would instead present AA honestly as a religiously based recovery program that works for some people, AA would be a real help to people with alcohol problems.

As is, AA does more harm than good. I hope AA changes so that it helps more people, but I’m not optimistic.